How COVID-19 Snuck Up on a Hospital Urology Department

Infection preventionists (IPs) and other health care professionals had been warned just how vulnerable they were to contracting COVID-19 almost from the very beginning of the pandemic. Health care professionals had also beenwarned that that vulnerability extends to what could be considered social settings in a hospital, such as lunchrooms or breakrooms.

SARS-CoV-2 moves fast, often with the help of asymptomatic carriers. By the time an IP discovers the first health care employee who has gotten COVID-19, it’s very possibly too late to prevent an outbreak among staff, according to a study in the American Journal of Infection Control.

“Our study shows that containment of a single SARS-CoV-2 infection within a department is particularly difficult once the spread has started, resulting in an exponential spread of SARS-CoV-2 infections,” write investigators with Mainz University Medical Center in Germany.

While the wearing of personal protective equipment (PPE) matters, proper airflow in a hospital setting also needs to be maintained.

“When treating patients with known COVID-19 infection or suspicious of COVID-19, full PPE was used (FFP2 mask, face shield or goggles, gown, double gloves),” the study states. “Of note, the wards and lunchrooms are not equipped with ventilation systems [except] for regular windows. In contrast, all the operation rooms have a ventilation system which is mandatory.”

Contact Tracing

One health care professional (Patient 1) in the urology department at Mainz University Medical Center tested positive for COVID-19. But as has been dramatically, and too often tragically, proven over the course of the pandemic, finding an infected person does not tell providers how long the person has had COVID-19, let alone how far and wide he or she may have spread it. Patient 1 wound up causing 7 additional infections inside the medical center and another 7 outside the facility.

“During the first spread of SARS-CoV-2, it was assumed that viral transmission can occur up to 7–14 days before first symptoms set in, which is particularly relevant when preventive measures were not followed under all circumstances, which was the case in the early phase after implementation of safety measures,” the study states. “However, the exact timeframe of infectiousness before the onset of COVID-19 symptoms is still not clear, despite increasing knowledge about SARS-CoV-2.”

In March and April 2020, during COVID-19’s first surge, administrators at the medical center ordered that all employees be tested for the coronavirus with a real-time quantitative polymerase chain reaction (rt-qPCR) test, just as a precautionary measure. Patient 1 had returned from Austria complaining of mild flu-like symptoms. On March 14, 2020, Patient 1 tested positive for COVID-19.

The medical center used contact tracing which resulted in those who’d had direct contact with Patient 1 (called category 1 contacts) being quarantined for 14 days. During quarantine, they were tested for SARS-CoV-2 often “until symptoms ceased and 2 consecutive SARS-CoV-2 tests were negative,” the study states. Then those employees could return to work, according to recommendations by the Robert-Koch-Institute (RKI).

However, remember, a COVID-19 surge needed to be contained and health care workers were at a premium. The RKI adjusted its guidelines, saying that staff who’d had direct contact with a person with COVID-19 could have shortened quarantines.

All of the 7 urology department staff who contracted the disease had worked closely with Patient 1. “During work hours, they had all been wearing face masks, however, they had shared a lunchroom for breaks without wearing their face masks,” the study states.

On the 24th day of the outbreak, another staff member had tested positive for SARS-CoV-2 “had worked during one shift with a rotating nurse, who was tested positive shortly after. They had been wearing masks during work hours, but thorough inquiry revealed that they had shared a lunch without wearing face masks.”

Long COVID

Kevin Kavanagh, MD, a member of Infection Control Today®’s Editorial Advisory Board has warned about society’s focus on COVID-19 mortality rates, and what Kavanagh sees as a lack of concern about long COVID—how the disease can ruin your life (or at least make life more difficult) without killing you.

“One of the things that’s really frustrated me with this epidemic and pandemic is that people are totally focused on dying…,” he told ICT® in January. “But in actuality, the disabilities are much, much more concerning because that is even affecting the young people.”

In the urology department at Mainz University Medical Center, 3 of the staff who’d been infected appear to be suffering from long COVID. One staff member, who’d had mild asthma and was overweight before the pandemic, “experiences ongoing anosmia, ageusia and dysgeusia. He also describes frequent episodes of fatigue after moderate physical activity.”

Another developed unilateral paresthesia near the ophthalmic nerve. The third staff member suffers from cerebral microinfarctions and bilateral stenosis of the internal carotid arteries. That person has undergone one surgery on one side, and—as of the study’s writing—awaited surgery for the contralateral side. The 3 staff members were ages 47, 52, and 55 respectively.

The study concludes: “Outbreaks of SARS-CoV-2 are particularly difficult to contain in a medical setting, where employees work in close physical proximity. Stringent adherence to preventive measures, particularly wearing face masks at all times, seem to be effective. Middle-age individuals appear to be at greater risk for long-lasting symptoms of COVID-19, even after a moderately severe course of the infection.”